Quality of life and hearing after cochlear implant placement in patients over 60 years of age.

OBJECTIVE: Multicenter evaluation of the quality of life and quality of hearing after Nucleus® cochlear implant placement in patients over 60 years of age. REFERENCE AND METHOD: Evaluation was performed in patients receiving cochlear implants after the age of 60 years as a part of the Cochlear-Implanted Recipient Observational Study (Cochlear-IROS). This study is a prospective, international and long-term assessment which enables observation of recipients for up to three years after implantation. Data regarding subjective evaluation of the quality of life and quality of hearing were gathered before the first switch-on of the sound processor and one year afterwards. Standardized questionnaires were used in this evaluation, including Health Utility Index (HUI mk. III) and Speech, Spatial and Qualities of Hearing (SSQ) Scale. Data were also gathered regarding the aetiology of hearing loss, hearing aid usage, tinnitus and vertigo, as well as on the telephone usage and the professional status of recipients. RESULTS: Included in the evaluation, were 20 subjects who were over 60 years old at the moment of the cochlear implant surgery. The study group consisted of 12 men and 8 female patients. The average age of CI recipients at the moment of implantation was 67.8 years (min. 60, max. 80 years). The SSQ questionnaire outcomes regarding self-assessment in the field of ability to hear in everyday situations one year after the surgery indicate that speech understanding increased by 180%, spatial hearing increased by 135 % and quality of hearing increased by 98%. Overall quality of life before the first sound processor switch-on as assessed using the HUI questionnaire was at the level of 0.38 (on 0-1 scale, where 0 equals death, and 1 equals full health). One year after the implantation, this assessment increased by 33% (up to 0.5 on the scale). CONCLUSION: The effectiveness of the cochlear implantation in patients with severe hearing loss after 60 years of age with respect to the quality of life and hearing was confirmed. Statistically significant improvement was demonstrated in the self-assessment of patients in relation to the speech understanding, spatial hearing and quality of hearing, as well as quality of life.

Evaluation of fully biodegradable nasal packings in functional endoscopic sinus surgery ­ a multi-centre study.

THE AIM: This work was to compare an innovative solution, i.e. a fully biodegradable nasal packing Nasopore®, with a traditional one, in the aftercare of patients subjected to functional endoscopic sinus surgery. MATERIAL AND METHOD: Prospective, blinded study with sequential enrollment conducted at three study centres. One of the investigators evaluated during surgery the level of bleeding in each of the nasal cavities and at the end of surgery he applied the test packing, the biodegradable dressing Nasopore®, to one randomly chosen nasal cavity, and a control packing to the other one. The other investigator removed during aftercare the control packing and conducted the follow-up. During the control visits (24-48 hours, 10 and 30 days post-op.) the subjects evaluated their headache, pain in the nose, pressure in the forehead as well as their nasal obstruction. RESULTS: A total of 39 women and 44 men at the age of 47 years on average (min. 19, max. 82) were qualified for the study. The largest differences between different types of nasal dressings were observed with regard to reduction of nasal obstruction in the fist 10 days after surgery (P<0.005). In relation to the pain in the area of the head and nose as well the pressure in the forehead on every visit, better outcomes were observed for the test dressing. Statistical difference (P<0.05) was observed on the fist follow-up visit for the headache and pressure in the forehead as well as on the fist and second visit for the pain in the nose. CONCLUSION: The fully biodegradable nasal dressing Nasopore® may constitute significant improvement and facilitation of aftercare in functional endoscopic sinus surgery while increasing the patients' satisfaction and lowering the postoperative discomfort.

Evaluation of Bone Conduction Implant Stability and Soft Tissue Status in Children in Relation to Age, Bone Thickness, and Sound Processor Loading Time.

OBJECTIVE: To measure the stability, as determined by implant stability quotient (ISQ) values, of bone conduction implants placed using FAST (one-stage) surgery in children to look for the differences between various ages and indications. To monitor the status of the peri-implant soft tissue using the classification proposed by Holgers et al. STUDY DESIGN: It was a prospective, open, multicenter study performed in two investigation centers. PATIENTS: Twenty-two subjects under 18 years of age implanted with the Cochlear BIA300 and BIA400 types of devices at the ENT Departments of Children's Hospitals in Bydgoszcz and Lodz in Poland. INTERVENTION(S): Implantation and use of the bone conduction implant system. The implants were placed unilaterally or bilaterally according to a one-stage surgical procedure as per normal practice at the hospitals. Loading time was adjusted to individual patient, and it was based on the assessment of implant stability and status of the soft tissue. MAIN OUTCOME MEASURE(S): The attention was given to the differences in the ISQ values obtained during the subsequent visits in the various age and indication groups. Resonance frequency analysis was performed as per the routine follow-up schedule at the hospital. RESULTS: Age at the time of implantation on average was 9.8 years (min. 5.2 yr; max. 16 yr). On average, ISQ value on each of the study observations in this group equaled to 59.17 (median, 58.79). Seventh to tenth day post-surgery seemed to be a sensitive period as the lowest ISQ values (on average: 56.38 ISQ) were recorded for these dates. On average, implant was loaded 7.5 weeks after surgery in the study group (min. 2 wk, max. 14 wk). In none of the subjects the significant decrease of the implant stability values after sound processor loading was observed. Statistically significant correlation rate (p < 0.05) showed that the thicker the bone the higher the obtained ISQ value on each of the visits. It was also confirmed that the younger the implanted child, the higher the skin reactions grade at the 2 to 4 weeks post-sound processor fitting. There was no correlation observed between the time of the sound processor fitting and the skin reactions status.

[The assessment of hearing impairment in patients over 60 years of age using hearing aids]. / Ocena niedosluchu u osób powyzej 60. roku zycia korzystajacych z aparatów sluchowych.

OBJECTIVE: To assess the hearing impairment in people over 60 years old using hearing aids. This was a single-center study, but it is planned to extend it further to the whole country. MATERIALS AND METHODS: The study was focused on patients with hearing aids. During the assessment 57 people were included in the observation in order to control the status of their hearing loss and benefit from traditional hearing aids as well as the possibility to apply the auditory implants in case of a little benefit from hearing aids. The otoscopy and pure tone audiometry were performed as well as the questionnaires on demographic and epidemiological data of patients were collected as well as the quality of their life with hearing aids was subjectively assessed. RESULTS: The results show that 91% of patients have sensorineural hearing loss (SHL), the remaining 9%--severe mixed hearing loss. Severe SHL was found in 22 patients, the moderate hearing loss was observed in 37%, and the profound SHL was the case in 5 patients. Minimal SHL was observed in 7% of patients (n=4). More than 73% of the study subjects were male (n=38). The average age of the patients who completed the survey was 74 years old. Thirty-five patients used their hearing aid over 3 years and less than 70% of them used it every day all day. Hearing aid was not actively used by 10 patients. Over the last year 51.92% of the patients underwent a hearing examination. CONCLUSIONS: The bone anchored hearing aid was suggested to 2% of subjects and the cochlear implant was offered to 10 patients. The data analysis shows the need to educate and inform the elderly about alternative methods of hearing loss treatment.

[Epidemiological and demographic analysis of indications for Baha® surgery in Poland--multicenter study]. / Analiza epidemiologiczna i demograficzna wskazan do implantacji systemu Baha® w Polsce--badanie wieloosrodkowe.

AIM OF THE STUDY: To collect and analyze epidemiological and demographical data of patients qualified for and implanted with the Baha® system in Poland. MATERIAL AND METHOD: 17 out of 28 otolaryngology departments performing Baha® implantation in Poland participated in the study. Up to date there were 286 patients registered in database. Data were obtained from the preoperative questionnaires including information such as age and gender, indications for the implantation, previous hearing aid use as well as data regarding the surgical technique. RESULTS: The most frequent indication for the Baha® system was bilateral mixed hearing loss (51%), followed by SSD (18%), bilateral conductive hearing loss (17%), unilateral mixed (8%) and conductive (6%) hearing loss. In 11% of subjects hearing impairment was congenital versus 89% cases of acquired. The mean age was 44 years with the slight prevalence of women (52%). 63% of patients did not have previous experience with hearing aids. The most frequent surgical technique was classic dermatome single stage procedure performed under general anesthesia (65%). CONCLUSIONS: Data gather in this multicentre research serve as a valuable source of information on qualifications for the Baha®, shows demographic spectrum of adult recipients in Poland. It also presents the preferences of surgical procedures. Outcomes of the study may constitute a reference for each centre participating in this research as well as for new centers starting the Baha® procedure.